[Sudden cardiac death in Italy: prevention and intervention strategies]

Sudden cardiac death remains a major clinical and social challenge. The number of cases still remains higher in Italy, both involving patients suffering from overt heart disease and those otherwise healthy. The heterogeneous mechanisms leading to cardiac arrest call for a comprehensive preventive strategy plan that combines clinical assessment, advanced diagnostic tools, and public health initiatives. The need for counteracting a transient period of elevated risk - as in post-infarction - forces to the use of a wearable cardioverter-defibrillator as it provides temporary protection while awaiting definitive reassessment. On the contrary, when cardiac arrest affects young and apparently healthy individuals, preventive efforts necessarily extend to their families to identify inherited conditions that would otherwise remain unrecognized. In the out-of-hospital setting, survival largely depends on the actions taken within the first few minutes. Therefore accessible defibrillators, widespread community training, and the active involvement of law enforcement agencies and schools can significantly enhance the response to out-of-hospital cardiac arrest. This paper ultimately outlines a roadmap that integrates clinical risk stratification, the expansion of territorial networks, broad training initiatives, and consistent institutional coordination. The goal is to establish a coherent national framework that can reduce regional disparities, enhance the early identification of at-risk individuals, and improve survival rates after cardiac arrest.